Health Reform 101 by UHPP
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Transcript of Health Reform 101 by UHPP
Health Reform 101 The Road Ahead for Healthcare Policy in Utah
September 2016
Key Terms
Private insurance plans sold on healthcare.gov with monthly premiums subsidized for some people
ACA or Obamacare Insurance
Why is the Affordable Care Act (ie. Obamacare) still viewed unfavorably by a majority of Utahns/Americans?
Who is benefiting from the Affordable Care Act now and in the future? Will the Affordable Care Act end up like the G.I. Bill, or “No Child Left Behind ?”
Three Key Questions
1
2
3
Open Enrollment
Open Enrollment
Special Enrollment
2016
JANUARY 1 FEBRUARY 1 NOVEMBER 1
The new health insurance calendar
Next Open Enrollment: Nov. 1, 2016 -- Jan. 31, 2017
OCTOBER 31
Open Enrollment
Open Enrollment
Special Enrollment
2017
JANUARY 1 FEBRUARY 1 NOVEMBER 1 OCTOBER 31
What is a Qualifying Life Event? ….that triggers a Special Enrollment Period
How the ACA changed healthcare (as we know it)
Adults under age 26 can stay on
their parents insurance
plan
Men and women pay the same for coverage
Insurance offers free preventative care like blood pressure checks, flu shots, and health screenings
No one can be denied or priced out of coverage for a
pre-existing condition
No lifetime caps on insurance payments
2010 2013
18.4%
29.0% Utah Uninsured Rate Ages 18-26:
Source: Utah DOH
The ACA’s most popular reforms are also the least likely to be attributed to the ACA…
Source: Kaiser Family Foundation Health Tracking Poll (conducted March 5-10, 2013); http://kff.org/health-reform/poll-finding/march-2013-tracking-poll/
What are the penalties for remaining uninsured in 2016?
[Chart] Kaiser Family Foundation
$285 $975 $2,085 Max per family
$95/adult, $47.50/child
$325/adult $162.50/child
$695/adult $347.50/child
We Are Here
Utah’s ACA sign-ups reached 164,415 in March 2016
[OE1-a] Health Insurance Marketplace: February Enrollment Report (Oct. 1, 2013-March 1, 2014), http://aspe.hhs.gov/health/reports/2012/ACA-Research/index.cfm; [OE1-b] Health Insurance Marketplace: November Enrollment Report (November 13, 2013), For the period: October 1, 20134 - November 2, 2013, https://aspe.hhs.gov/sites/default/files/pdf/180496/rpt_enrollment.pdf [OE1-c] Health Insurance Marketplace: January Enrollment Report (January 13, 2014), For the period: October 1, 2013 – December 28, 2013, https://aspe.hhs.gov/sites/default/files/pdf/177611/ib_2014jan_enrollment.pdf [OE1-d] Health Insurance Marketplace: February Enrollment Report February 12, 2014), For the period: October 1, 2013 – February 1, 2014, https://aspe.hhs.gov/sites/default/files/pdf/177606/ib_2014feb_enrollment.pdf [OE1-e] Health Insurance Marketplace: March Enrollment Report (March 11, 2014), For the period: October 1, 2013 – March 1, 2014, https://aspe.hhs.gov/sites/default/files/pdf/76811/ib_2014Mar_enrollAddendum.pdf [OE1-f] Health Insurance Marketplace: Summary Enrollment Report: State Profile, (May 1, 2014), https://aspe.hhs.gov/sites/default/files/pdf/93806/ut.pdf ----------- [OE2-a] Health Insurance Marketplace: December Enrollment Report, (December 30, 2014), For the period: November 15, 2014 – December 15, 2014, https://aspe.hhs.gov/sites/default/files/pdf/77201/ib_2014Dec_enrollment.pdf [OE2-b] Health Insurance Marketplace: January Enrollment Report, (January 27, 2015), For the period: November 15, 2014 – January 16, 2015, https://aspe.hhs.gov/sites/default/files/pdf/33826/ib_2015jan_enrollment.pdf [OE2-c] Health Insurance Marketplace: March Enrollment Report, (March 10, 2015), For the period: November 15, 2014 – February 22, 2015, https://aspe.hhs.gov/sites/default/files/pdf/83656/ib_2015mar_enrollment.pdf; [OE2-d] State-Level Data from the ASPE January Health Insurance Marketplace Enrollment Report For The 2016 Open Enrollment Period; March 31, 2015 Effectuated Enrollment Snapshot; 15-06-02; http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-06-02.html ----------- [OE3-a] Health Insurance Marketplace: January Enrollment Report, (January 7, 2016), For the period: November 1, 2015 – December 26, 2015, https://aspe.hhs.gov/sites/default/files/pdf/167981/MarketPlaceEnrollJan2016.pdf; [OE3-b] Health Insurance Marketplace Open Enrollment Snapshot - Week 11; January 10, 2016 - January 16, 2016 (Released: 1/20/16); Health Insurance Marketplace Open Enrollment Snapshot - Week 13 January 24, 2016-February 1, 2016; https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-02-04.html; [OE3-c] Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report (March 11, 2016), For the period: November 1, 2015 – February 1, 2016, https://aspe.hhs.gov/sites/default/files/pdf/187866/Finalenrollment2016.pdf; [OE3-d] March 31, 2016 Effectuated Enrollment Snapshot (Released: June 30, 2016), https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-06-30.html
164,415
-
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
200,000
The drop of “effectuated” enrollment in 2016 was smaller than in previous years
84601
140,612
175,637
84,601
128,220
164,415
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
200,000
OE1 (2013-14) OE2 (2014-15) OE3 (2015-16)
(REGULAR) [OE1] Health Insurance Marketplace: February Enrollment Report (Oct. 1, 2013-March 1, 2014), http://aspe.hhs.gov/health/reports/2012/ACA-Research/index.cfm; [OE2] Marketplace Plan Selection by Age in States Using the HealthCare.gov Platform, By State (1); 11-15-14 to 2-15-15 (including SEP activity through 2-22-15), (Released: March 10, 2015), http://aspe.hhs.gov/health/reports/2015/MarketPlaceEnrollment/Mar2015/ib_2015mar_enrollment.pdf; [OE3] Addendum to the Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report; For the period: November 1, 2015 – February 1, 2016, (Released: March 11, 2016), https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-final-enrollment-report (EFFECTUATED) [OE1] Health Insurance Marketplace: February Enrollment Report (Oct. 1, 2013-MArch 1, 2014), http://aspe.hhs.gov/health/reports/2012/ACA-Research/index.cfm; [OE2] March 31, 2015 Effectuated Enrollment Snapshot (Released June 2, 2015), http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact- sheets-items/2015-06-02.html; [OE3] March 31, 2016 Effectuated Enrollment Snapshot (Released: June 30, 2016), https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-06-30.html
-8.8%
-6.4%
Effectuated
Initial
Utah enrollment grew by 36,195 between 2015-16 effectuated enrollment totals
Sources: [OE1] Health Insurance Marketplace: February Enrollment Report (Oct. 1, 2013-MArch 1, 2014), http://aspe.hhs.gov/health/reports/2012/ACA-Research/index.cfm; [OE2] March 31, 2015 Effectuated Enrollment Snapshot (Released June 2, 2015), http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-06-02.html; [OE3] March 31, 2016 Effectuated Enrollment Snapshot (Released: June 30, 2016), https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-06-30.html
84,601
128,220
164,415
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
OE1 (2013-14) OE2 (2014-15) OE3 (2015-16)
Nationally, 20 million Americans have gained health insurance due to the ACA and Medicaid Expansion
Source: The Office of the Assistant Secretary for Planning and Evaluation’s (ASPE) analysis of the Gallup-Healthways Well-Being Index survey data through February 22, 2016.
Utah’s uninsured rate is decreasing… …but the most recent data indicates a slowdown
Sources: Census SAHIE: https://www.census.gov/library/publications/2015/demo/P60-253.html DOH (BRFSS): http://ibis.health.utah.gov/pdf/opha/publication/ins/InsHighlights_2014.pdf Gallup Healthways: “Arkansas, Kentucky Set Pace in Reducing Uninsured Rate;” 2/4/16; [2015] http://www.well-beingindex.com/arkansas-kentucky-reduce-uninsured-rateBeing&utm_medium=newsfeed&utm_campaign=tiles
16.7%
15.7%
16.3%
15.9%
16.7% 16.6%
15.7%
14.0%
12.5%
9.1%
10.2%
11.6%
11.9%
10.6% 10.7%
11.2%
10.6%
13.4%
13.2%
11.6%
10.3%
15.6%
13.3%
12.4%
8%
9%
10%
11%
12%
13%
14%
15%
16%
17%
18%
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
UT: Census/SAHIE
UT:DOH (BRFSS)
UT: Gallup-Healthways
Over half of Utah’s ACA enrollment is under age 34
Utah
Healthcare.gov (34 states)
23%
32% 16%
13%
15%
Under 18
18-34
35-44
45-54
55-649%
28%
16%
21%
25% Under 18
18-34
35-44
45-54
55-64
55%
44% 0-34
35-64
Source: Addendum to the Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report; For the period: November 1, 2015 – February 1, 2016 https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-final-enrollment-report ; Released: March 11, 2016
Age
Age
Age
37%
62%
0-34
35-64
Age
Race Status Utah
Healthcare.gov (34 states)
1%
4%
0% 1%
10%
83%
2%
American Indian / Alaska Native
Asian
Native Hawaiian / Pacific Islander
African-American
Latino
White
Multiracial
0%
9% 0%
12%
15% 63%
1%
Source: Addendum to the Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report; For the period: November 1, 2015 – February 1, 2016 https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-final-enrollment-report; Released: March 11, 2016
17% of Utahns enrolling on healthcare.gov describe themselves as racial minorities
Rural Status Utah
Healthcare.gov (34 states)
Source: Addendum to the Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report; For the period: November 1, 2015 – February 1, 2016 https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-final-enrollment-report; Released: March 11, 2016
15% of Utahns enrolling on healthcare.gov live in rural ZIP codes
15%
85%
Rural ZIP Codes
Urban ZIP Codes
18%
82%
Rural ZIPCodes
Urban ZIPCodes
Most Utahns choose Silver-level plans that offer a balance between premiums and cost-sharing
15%
74%
11%
Utah
1%
21%
71%
6% 1%
Source: Addendum to the Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report; For the period: November 1, 2015 – February 1, 2016 https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-final-enrollment-report ; Released: March 11, 2016
Healthcare.gov (34 states)
Subsidy Status
85% of Utahns enrolling on healthcare.gov received a premium subsidy
No subsidy
Received subsidy
Source: Health Insurance Marketplaces 2016; Average Premiums After Advanced Premium Tax Credits in the 38 States Using the Healthcare.gov Eligibility and Enrollment Platform; Nov. 1-Dec. 26, 2015; Released 1/21/16
87%
13%
Utah
No subsidy
Received subsidy
85%
15%
Healthcare.gov (34 states)
Premium subsidies make health insurance more affordable in Utah
Impact of subsidies on Utah consumer costs
ACA enrollment in Utah by % poverty level
Consumer
Cost
2%
34%
25%
21%
16% Under 100%
100% to 150%
150% to 200%
200% to 250%
250% to 400%
Source: Addendum to the Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report; For the period: November 1, 2015 – February 1, 2016 https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-final-enrollment-report ; Released: March 11, 2016
$187
$84
Subsidy
Amount
(69%)
(31%)
Average UT Monthly Premium: $271
In 2016, the average monthly per-person premium subsidy in Utah is $187/month
Consumer
Cost
Subsidy
Amount
$187
$290
$84
$106
$0
$50
$100
$150
$200
$250
$300
$350
$400
$450
Utah Hea;thcare.gov (34 states)
Utah Healthcare.gov (34 states)
Source: Addendum to the Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report; For the period: November 1, 2015 – February 1, 2016 https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-final-enrollment-report ; Released: March 11, 2016
Subsidy Amount
$271
$396
Over half of re-enrolling ACA consumers in Utah switched health plans in 2016
Origin of all Utah consumers
Plan selection by all Utah re-enrolled consumers
Newly enrolled
Re-enrolled
Switched plan
Same plan
58%
42%
Source: Addendum to the Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report; For the period: November 1, 2015 – February 1, 2016 https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-final-enrollment-report; Released: March 11, 2016
56% 44%
71% of “Active” re-enrolled consumers in Utah switched plans in 2016
Plan selection by all Utah “Active” re-enrolled
Switched plan
Same plan
Source: Addendum to the Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report; For the period: November 1, 2015 – February 1, 2016 https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-final-enrollment-report; Released: March 11, 2016
Plan selection by all Healthcare.gov
“Active” re-enrolled
Switched plan
Same plan
70.8%
29.2%
61.0%
39.0%
Sources: [2014] https://https://insurance.utah.gov/health/Health%20Refrom/ACA_Rate_Individual_20131007_OnExchange.pdf [2015] Utah – On Exchange Rates (accurate as of 10/15/14) https://insurance.utah.gov/health/Health%20Refrom/2015IndividualOnExchange20141016.pdf [2016] www.hea;thcare.gov; See Plans and Premiums (October 2015)
Altius Health Plans Arches BridgeSpan Humana Molina Healthcare Select Health
6 plans
26 plans
34 plans
24 plans
1 plan
Humana (6) Molina Healthcare (3) Select Health (60) University of Utah (5)
2015: 101 Plans 2016: 74 Plans
Altius Health Plans Arches BridgeSpan Humana Molina Healthcare Select Health
2014: 91 Plans
Gold
Silver
Bronze
Catastrophic
Platinum
5 plans
19 plans
27 plans
21 plans
2 plans
5 plans
29 plans
40 plans
27 plans
0 plans
2014-16 Individual Marketplace Comparison Salt Lake County
Note: Humana will exit the marketplace in 2017
(*) Premium costs do not include subsidies
Sources: [2014] https://https://insurance.utah.gov/health/Health%20Refrom/ACA_Rate_Individual_20131007_OnExchange.pdf [2015] Utah – On Exchange Rates (accurate as of 10/15/14) https://insurance.utah.gov/health/Health%20Refrom/2015IndividualOnExchange20141016.pdf [2016] Utah 2016 ACA Individual & Small Group Enrollment and Premium Rates; Utah Dept. of Insurance (October 2015)
In Salt Lake County, benchmark premiums rose 13% in 2016
$112
$197 $209
$301
$424
$115
$202 $215
$309
$436
$131
$229 $244
$350
$494
$-
$100
$200
$300
$400
$500
$600
20 30 40 50 60
Monthly Premiums* for Benchmark Silver Plan by Age (2014-15-16) Salt Lake County
Age
2014 2015 2016
Why are people dropping their coverage mid-year?
Insurance Dropouts Present a Challenge for Health Law New York Times By Abby Goodnough October 11, 2015
Link: http://www.nytimes.com/2015/10/12/us/insurance-dropouts-present-a-challenge-for-health-law.html
1) Premium cost
2) Under utilization
3) Paperwork errors
0% 101% 400% 100%
Who is eligible for premium subsidies?
Income as % of the Federal Poverty Level (FPL)
NO YES 53,000 Utahns
in the Gap
Sliding-scale subsidies make insurance more affordable
Source: http://www.coloradohealthinsurancebrokers.com/wp-content/uploads/2013/08/2015-2016-FPL-Chart-1024x314.jpg
For 2016, a family of four can earn $97,000 a year and receive a premium subsidy
If your income/family size is on this chart, you qualify for a subsidy
The Hernandez Family Income: $26,000 Residence: Salt Lake City, Utah Ages: Dad : 33 Mom: 29 Kids: 11, 7
Annual income: $26,000
% of poverty level: 109%
Monthly premium: $458
Subsidy pays: $410 per month
The Hernandez’s pay: $48 per month
Benchmark Silver Plan
Primary doctor: $5 Specialist doctor: $15 Emergency room care: $150 Generic drugs: $6
Plan Details
2016 rate change: + $4/month
Deductible: $1000 Out-of-pocket maximum: $1,500 Source: https://www.healthcare.gov/see-plans/; Image source: Moodboard
Annual income: $44,000
% of poverty level: 222%
Monthly premium: $537
Subsidy pays: $274 per month
The Shumways pay: $262 per month
Benchmark Silver Plan
Primary doctor: $35 Specialist doctor: $60 Emergency room care: $500 Generic drugs: $10
Plan Details
Deductible: $2,300 Out-of-pocket maximum: $10,900
2016 rate change: +$1/month
The Shumways Income: $44,000 Residence: American Fork, UT Ages: Dad : 24 Mom: 23 Kid: Newborn
Source: https://www.healthcare.gov/see-plans/
Mr. and Mrs. Smith Income: $42,000 Residence: Santa Clara, Utah Ages: 60, 62
Annual income: $42,000
% of poverty level: 267%
Monthly premium: $1,188
Subsidy pays: $865 per month
The Smiths pay: $323 per month
Benchmark Silver Plan
Primary doctor: $35 Specialist doctor: $60 Emergency room care: $600 Generic drugs: $10
Plan Details
Deductible: $2,500 Out-of-pocket maximum: $13,700
2016 rate change: + $13/month
Source: https://www.healthcare.gov/see-plans/; Image source: Moodboard
The Simonsen Family Income: $135,000 Residence: Alpine, Utah Ages: Dad : 35 Mom: 44 Kids: 11, 7
Annual income: $135,000
% of poverty level: 555%
Monthly premium: $757
Subsidy pays: $0 per month
The Simonsen’s pay: $757 per month
Benchmark Silver Plan
Primary doctor: $35 Specialist doctor: $60 Emergency room care: $600 Generic drugs: $10
Plan Details
Deductible: $2,500 Out-of-pocket maximum: $13,700 Source: https://www.healthcare.gov/see-plans/; Image source: Moodboard
Annual income: $21,000
% of poverty level: 89%
Expected contribution: 100%
Monthly premium (for 2): $482
The Smith’s pay: $482
Subsidy pays $0
The Smith Family Income: $21,000 Residence: Orem, Utah Ages: Dad : 35 Mom: 33 Child: 7 Child: 11
No Subsidy
The Smith’s healthcare costs would be 27% of their total income
Who lives in the Coverage Gap?
Source: https://www.healthcare.gov/see-plans/; Image source: Fotozalc
Window-shop for insurance
https://www.healthcare.gov/see-plans
Who is signing up for the ACA in Utah?
Image source: WarrenFree
In 2016, 13 of Utah’s top 20 ZIP codes for ACA enrollment were outside of Salt Lake
County
Source: 2016 Health Insurance Marketplace Plan Selections by ZIP Code; (Nov. 1, 2015 — Jan. 9, 2016); https://aspe.hhs.gov/basic-report/plan-selections-zip-code-health-insurance-marketplace-january-2016
RANK CITY SELECTIONS % INCREASE 1 Lehi (84043) 3,501 19% 2 South Jordan (84095) 3,346 12% 3 American Fork (84003) 2,948 17% 4 Pleasant Grove (84062) 2,931 20% 5 St. George (84790) 2,829 10% 6 St. George (84770) 2,742 11% 7 Draper (84020) 2,624 13% 8 Bountiful (84010) 2,455 5% 9 Spanish Fork (84660) 2,377 24%
10 West Valley City (84119) 2,368 3% 11 West Valley City (84120) 2,345 13% 12 Provo (84604) 2,289 22% 13 Herriman (84096) 2,276 20% 14 Clearfield (84015) 2,258 3% 15 Riverton (84065) 2,255 23% 16 Cottonwood Heights (84121) 2,254 6% 17 Orem (84058) 2,196 24% 18 Orem (84057) 2,193 16% 19 Ogden (84404) 2,189 1% 20 Layton (84041) 2,110 12%
County Open Enrollment #3
(1/9/16) % Change since Open Enrollment #2
(2/22/15) County Population
(2014)
Salt Lake
52,360 7.1%
1,091,742
Utah
32,987 17.3%
560,974
Davis
14,263 9.8%
329,692
Weber
9,753 5.2%
240,475
Washington
10,437 12.4%
151,948
Cache
5,672 8.0%
118,343
Tooele
2,086 4.4%
61,598
Box Elder
2,023 9.4%
51,518
Iron
2,380 12.2%
47,269
Summit
3,034 13.3%
39,105
Uintah
1,039 7.1%
36,867
Sanpete
1,272 7.4%
28,477
Wasatch
2,118 5.7%
27,714
Carbon
638 -2.6%
20,660
Grand
904 -12.1%
9,429
Utah and Washington counties continue to lead ACA sign-ups in Utah
Sources: [OE2] Plan Selections by ZIP Code in the Health Insurance Marketplace (November 15, 2014 thru February 22, 2015) http://aspe.hhs.gov/health/reports/2015/MarketPlace-Enrollment/EnrollmentByZip/rpt_EnrollmentByZip_Apr2015.cfm [OE3] Plan Selections by ZIP Code in the Health Insurance Marketplace: (November 1, 2015 thru January 9, 2016) https://aspe.hhs.gov/basic-report/plan-selections-zip-code-health-insurance-marketplace-january-2016
Recent data suggests that Utah is falling behind other states in key health reform metrics
Sources: 2013, 2014; Gallup Healthways Well-Being Index (2/24/15); 2Q 2015 US: Gallup Healthways Well-Being Index (7/10/15); 2Q 2015 UT: Gallup Healthways Well-Being Index (8/10/15) ; Smith, Jessica C. and Carla Medalia, U.S. Census Bureau, Current Population Reports, P60-253, Health Insurance Coverage in the United States: 2014, U.S. Government Printing Office, Washington, DC,2015.
What ACA enrollment looks like
Who are the helpers? Navigator
Certified Application Counselor
Experts trained to help others evaluate their insurance options on the new insurance marketplace.
Image: Paramount Pictures Corporation
www.takecareutah.org | call 2-1-1
TCU’s trained counselors are ready to help you understand your new options to find affordable
health care coverage today
Where can Utahns find help applying for health insurance?
Utahans are still falling through the cracks
Source: “Utahns brace for Obamacare enrollment, year 2,” by Kristen Moulton, Salt Lake Tribune, 11/11/14; http://www.sltrib.com/news/1812058-155/insurance-hobson-says-utah-gov-plans?page=1
“First, the HealthCare.gov website had her application "processing" for two months. Then the exchange needed a
form from her employer. When she finally got insurance, it was at a rate far higher than it should have been and she was never given a card or even an address for sending a payment.” …. It’s irritating, because I really tried.”
November 11, 2014
Coverage Gap 101 Fixing Utah’s Persistent Healthcare Challenge
405,000 Utahns received Medicaid in 2014
The largest Medicaid recipient category in Utah are children under age 19 (238,950 recipients)
Utah adults without children aren’t eligible for Medicaid at any income level
59.0% 13.8%
11.8%
4.0%
6.4% 5.0%
Children (age 0-18)
Parents
Visually Impaired and People with Disabilities
Elderly (age 65+)
Pregnant Women
Primary Care Network (PCN)
Source: Utah Dept. of Health 2014 Medicaid Report (p. 29); http://health.utah.gov/medicaid/stplan/LegReports/MedicaidAnnualReport_2014.pdf
In June 2012, the Supreme Court declared Medicaid expansion optional. Utah is among 22 states that
have not expanded coverage.
0% 138% 400%
Income as % of the Federal Poverty Level
101% 400% 0% 100%
AC A in 2 0 1 0 AC A af ter 2 0 1 2
Originally, the ACA required Medicaid Expansion
Income as % of the Federal Poverty Level
What is the Coverage Gap?
Utahns in the Gap 63,000
0% 101% 400% 100%
Premium subsidies aren’t available for people earning under the poverty line
Income as % of the Federal Poverty Level (FPL)
NO YES 53,000 Utahns
in the Gap
• People who can’t receive Medicaid include adults without kids, parents who earn more than 50% of poverty, and people with unqualified disabilities
• Many people who don’t quality for Medicaid are uninsured and live in Utah’s “Coverage Gap”
Who isn’t eligible for Medicaid?
Who is in the Coverage Gap?
Parents… students… full-time workers… family care-givers… people with disabilities… part-time workers… veterans… women who just gave birth
Todd Dad… grad student… has two part-time jobs
Wendy Single-mom… student… child on LDS mission
Rachel Mom… employee… in long-term recovery
FYI: People in the coverage gap work
The national picture...
Source: The Advisory Board Daily Briefing (1/13/16); https://www.advisory.com/daily-briefing/resources/primers/medicaidmap
31 states, D.C. expanding Medicaid
Who could be covered in Utah?
Utah’s coverage gap costs lives each year
0% 100%
How does full expansion differ from partial?
0% 100% 138%
70%
30%
10%
90%
STATE
FEDERAL
WHO PAYS
$82 million/year $513 million/year
Partial Expansion Full Expansion TYPE
PEOPLE COVERED
TAXES RETURNED*
Source Cost estimates based on Milliman Numbers Revised 12 /17/14 and Dept. of Health Estimates 03/03/15; Taxes Returned data for 2017.
Utah voters support a coverage gap solution